Friday, 21 November 2014

Yoga benefits who?

E-pub: Cramer et al. Yoga for Multiple Sclerosis: A Systematic Review and Meta-Analysis. PLoS One. 2014 Nov 12;9(11):e112414.

While yoga seems to be effective in a number of neuropsychiatric disorders, the evidence of efficacy in multiple sclerosis remains unclear. The aim of this review was to systematically assess and meta-analyze the available data on efficacy and safety of yoga in patients with multiple sclerosis. Medline/PubMed, Scopus, the Cochrane Central Register of Controlled Trials, PsycINFO, CAM-Quest, CAMbase, and IndMED were searched through March 2014. Randomized controlled trials (RCTs) of yoga for patients with multiple sclerosis were included if they assessed health-related quality of life, fatigue, and/or mobility. Mood, cognitive function, and safety were defined as secondary outcome measures. Risk of bias was assessed using the Cochrane tool. Seven RCTs with a total of 670 patients were included. Evidence for short-term effects of yoga compared to usual care were found for fatigue (standardized mean difference [SMD] = -0.52; 95% confidence intervals (CI) = -1.02 to -0.02; p = 0.04; heterogeneity: I2 = 60%; Chi2 = 7.43; p = 0.06) and mood (SMD = -0.55; 95%CI = -0.96 to -0.13; p = 0.01; heterogeneity: I2 = 0%; Chi2 = 1.25; p = 0.53), but not for health-related quality of life, muscle function, or cognitive function. The effects on fatigue and mood were not robust against bias. No short-term or longer term effects of yoga compared to exercise were found. Yoga was not associated with serious adverse events. In conclusion, since no methodological sound evidence was found, no recommendation can be made regarding yoga as a routine intervention for patients with multiple sclerosis. Yoga might be considered a treatment option for patients who are not adherent to recommended exercise regimens.


Yoga includes practices, philosophy and religion and has different schools, principles and goals. For the majority of people in the western world, yoga is usually a type of exercise that makes you stretch without breaking too much sweat (hot yoga excluded). The seven studies analysed included 670 people in the yoga (any type, duration or objective) or control (exercise, no exercise or other non-pharmacological intervention) groups.

You may know that government and health bodies recommendations for exercise are generic and similar for very different individuals. As for diets, the exercise recommendations are not evidence based: some forms of exercise can be deleterious for some people. On the other hand, sitting on the sofa and being inactive are definitely associated with bad health outcomes. So what is your objective when engaging in yoga? It may or not be "fatigue", "mood" and "health-related QoL".

The conclusion of this study makes you believe that there are recommended exercise regimens, which is not true. The best option is to choose whichever strategy keeps you active. In a more ideal world, you may want to have an individualised recommendation keeping in mind blood pressure, vital capacity, weight, and neurological objectives and adjust the strategy based on outcomes.

6 comments:

  1. I find doing yoga stretches really helps (counteract) stiffness in my legs, it also makes me focus on good posture, whether siting or standing. I don't have huge expectations of it but it certainly helps and I also get that 'feel good' feeling. I combine with core exercises and can do it at home which means I am more likely to do it on a regular basis.

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  2. I have RRMS and practise 15 minutes of yoga (and meditation) twice a day. Yoga reduces stress as with meditation. I know from experience that stress triggers relapses and also exacerbates my MS symptoms. The yoga and meditation both keep me aware of my stress and my anxiety has reduced. Stress can cause anxiety. Anxiety is common in MS. I do feel like my core is strengthening with the yoga and meditation. The yoga is also improving my core with regards to my posture, I stand and sit better/more equally balanced. My hamstrings are becoming less tight. There have been a few newspaper articles recently regarding introducing yoga in schools which may improve grades.
    My experience of yoga is very positive and I can see it becoming increasingly popular with MSers including seated yoga.

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  3. It's common sense, surely? There is no magic exercise bullet but anything that keeps you stretched and active without the danger of falls is good. I've done yoga and Pilates. A lot depends on the teacher, but I would say that Pilates exercises are more clearly linked to the musculo-skeletal system. As you're doing them, you're made very aware of the muscle groups you're trying to improve and this knowledge is helpful to one's understanding of where the MS deficits are. The exercises and equipment used have a big overlap with physiotherapy, in fact some are identical. I feel yoga is more 'whole-body/whole mind based', if that makes sense. Yoga and Pilates, I would say, are equally beneficial for stress reduction.

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  4. A few weekends ago I went on a yoga and meditation retreat. Before I left home to travel to the retreat my legs were aching badly when I stood up. It wasn't at a spa and it wasn't expensive. The whole weekend was about rest, rest and more rest. The day I left the retreat I felt very well rested, relaxed and no aching legs. I felt as good as I did before I got MS, I felt content and happy. I already meditate twice a day but it's amazing how much stress I can still accumulate. There was no TV just nice conversations, meals togther with others, listening to very relaxing music and going to bed before 10pm.

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  5. Yoga benefits me. I have a bit of nerve pain in my back when I do certain yoga poses. The ones leaning over. The nerves sting for a few days so I no longer do these poses. I informed my physiotherapist, her advice was why don't I take pain killers so I can do these poses as I enjoy the yoga so much. I also informed my yoga teacher, I didn't tell her why my physio advised me. My teacher advised me We don't do any poses which hurt us, we either modify the pose, or not do that pose, there are many other suitable poses.
    I'm sticking with my teachers advice, why would I take pain killers twice a day to do certain yoga poses twice a day??

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  6. Sounds Interesting... It is very informative and I Like this Post....

    Shaligram Shilas

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